The most common class of medications used to treat osteoporosis is antiresorptive drugs. Common side effects include heartburn, nausea, and trouble swallowing.

Osteoporosis is a disease characterized by a loss of bone mineral density that causes bones to become brittle and fragile. It’s a common problem among older adults, especially females.

People with osteoporosis are at an increased risk of bone fracture, so doctors often prescribe medications to reduce this risk. Medications can be effective at increasing bone mineral density for many people, but like all medications, they can also cause side effects.

The specific types of side effects depend on the class and type of medication you’re taking.

Let’s review the types of medications used for osteoporosis and highlight their common side effects.

The main medications prescribed for osteoporosis fall into three classes. Each class works differently to either slow bone breakdown or increase new bone formation.

Here’s an overview of each type.

Antiresorptive agents

Antiresorptive drugs slow down the breakdown of bone tissue, helping to maintain or increase your bone density.

The most common type of antiresorptive medications that doctors prescribe are called bisphosphonates. These include:

  • alendronate (Fosamax)
  • risedronate (Actonel, Atelvia)
  • ibandronate (Boniva)
  • zoledronic acid (Reclast)

Hormone therapies

Hormonal therapy may be considered for postmenopausal females. In the United States, hormone therapy is delivered in the form of estrogen therapy.

In some places, including several European countries, a synthetic hormone called Tibolone is sometimes administered. It mimics the effects of the hormones estrogen and progesterone.

Anabolic agents

Anabolic agents stimulate the formation of new bone. They may be recommended for people with severe osteoporosis. Drugs in this class have been FDA-approved since 2002.

Types of anabolic agents you may receive include:

  • teriparatide (Bonsity, Forteo): a synthetic form of parathyroid hormone, given by daily injection
  • abaloparatide (Tymlos): another parathyroid hormone-related protein, also given by injection
  • romosozumab (Evenity): a monoclonal antibody that increases bone formation and decreases bone breakdown, given by monthly injections for up to 1 year

Osteoporosis drug side effects can depend on which type of medication you’re taking. Here’s a look at potential side effects by drug class.

Antiresorptive medication side effects

The most common side effects of bisphosphonates, which are the most common medications in this class, are gastrointestinal. They might include:

Some bisphosphonates are administered orally, while others are administered through an IV. Bisphosphonates administered through an IV can cause flu-like symptoms, such as:

The symptoms are generally mild and resolve within a few days. Some people may also develop irritation or a reaction around the injection site.

Extremely rare but serious side effects of these medications can include:

Anabolic side effects

Common adverse effects of taking anabolic medications to treat osteoporosis include:

There’s some concern that these medications may increase the risk of a type of tumor called osteosarcoma. An increased risk of these tumors has been seen in rat studies but not in humans.

Hormone therapy side effects

Potential side effects of hormone therapy for osteoporosis include:

Additionally, estrogen therapy may increase your risk of certain conditions, such as:

There’s no best medication for everybody with osteoporosis. Your doctor can work with you to help you understand the pros and cons of each medication and decide which might be best.

Bisphosphonates are usually the first-line treatment and are well-tolerated by many people. However, their most common side effects are gastrointestinal, and they may not be suitable for some people. For example, if you’re taking proton pump inhibitors, your medical professional may recommend medications less likely to cause these symptoms.

All medications come with some risk. The most common medications to treat osteoporosis, bisphosphonates, are generally safe, but they can cause serious complications like kidney failure.

Whether osteoporosis drugs are worth it depends on factors like the severity of your osteoporosis. Your doctor can best advise you on the best medication for you.

There’s no single drug that’s the safest, but bisphosphonates are often the first-line medications prescribed and generally have good tolerability.

For people with milder osteoporosis, making lifestyle changes alone might be enough to keep the condition well managed. Lifestyle changes you can make include avoiding smoking, eating a diet high in vitamin D and calcium, and exercising regularly.

Learn more about osteoporosis treatment.

The most common medications used to treat osteoporosis are called bisphosphonates. These medications are generally safe with a low risk of side effects. However, some may develop serious side effects like bone tissue death or acute kidney failure.

The specific side effects you develop depend on the class of medication you’re taking and the specific drug you’re taking. It’s a good idea to speak with your doctor about what to expect before starting a new medication.